Autologous Millifat Grafting as a Reconstructive Strategy for Complex Lower Limb Defects in a Diabetic Patient After Necrotizing Fasciitis

Lower limb ulcers, especially in patients with diabetes mellitus, represent a major therapeutic challenge, particularly when complicated by severe infections such as necrotizing fasciitis. These conditions often require extensive surgical interventions, including amputation. We present the case of a 68-year-old female patient with poorly controlled type 2 diabetes mellitus who developed extensive necrotizing fasciitis in the left lower limb following trauma with plant material, resulting in a large soft tissue defect. The patient was not a candidate for regional or distant flaps due to her non-revascularizable micro- and macroangiopathic disease. A prior CT angiography showed complete occlusion of the anterior and posterior tibial arteries, evaluated by Orthopedics, who indicated amputation of the limb. Due to the patient's refusal to undergo amputation, autologous millifat grafts were selected for the salvage treatment strategy. This case highlights the potential of this technique as a limb salvage tool, demonstrating its effectiveness in complex clinical scenarios by promoting tissue regeneration and avoiding major ablative procedures.